A 2 year old boy is brought in to ED by his grandparents, having found him unresponsive at their home. He has no significant past medical history.

On examination he is drowsy with a GCS of 7 (E2V1M4) and has the following observations:

BP 80/50  mmHg

HR   140/min

RR  18/min

O2 sats  100% on 2 litres nasal cannula

T 36.5

His VBG is as follows:

pH  7.1   (7.35-7.45)

O2    50  mmHg

CO2   37    mmHg    (40-50)

HCO3   11 mmol/l    (24-32)

Lactate   8.8   (0.5-2)

Na   143   mmol/l  (135-145)

K   3.8  mmol/l   (3.5-4.8)

Cl   110   mmol/l   (95-110)

Glu   1.8   mmol/l   (3-6)

Questions:

1. List the acid base abnormalities

2. Give an appropriate differential diagnosis

3. What are the normal vital sign parameters for this age group?

4. What are your initial resuscitation priorities?